| NPI | 1619103868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH5539) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL AL6082627) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2022-02-25 |